David Cameron has announced a radical reworking of the government’s NHS reform plans which will give hospital doctors and nurses mandated places on GP commissioning consortium boards.

The prime minister also said in a speech on Tuesday there would be a change to the proposed duties of economic regulator Monitor, a slower handover of commissioning to consortia, and the introduction of new sub-regional bodies called “clinical senates”.

Mr Cameron said: “Hospital doctors and nurses will be involved in clinical commissioning.” HSJ understands this means consortia will be required to appoint a hospital doctor and a nurse to their boards.

New rules will attempt to prevent conflicts of interest, such as the appointment of the medical director of a trust from which a consortium commissions a significant amount of care. It is believed there will be no barriers to a consortium choosing a nurse representative employed by one of their practices.

Since announcing his proposals in July, health secretary Andrew Lansley has consistently said consortia should be allowed to choose how they govern themselves.

HSJ understands that apart from GPs, hospital doctors and nurses, no other type of representatives will be mandated for consortium boards, despite calls for them to include groups including non-executive directors and patient representatives.

Mr Cameron also said the government would “introduce clinical senates, where groups of doctors and healthcare professionals come together to take an overview of the integration of care across a wide area”. These are likely to be sub-regional networks of clinicians from all sectors, whose organisational form and powers have yet to be decided.

The prime minister also confirmed the continuing role of “effective” commissioning networks. “We will support them, not reinvent the wheel,” he said.

The decision to give nurses a board seat was welcomed by the Royal College of Nursing. General secretary Peter Carter said: “Most of the progressive GPs and secondary care consultants recognise that if you want something to work… you have to have nurses involved.”

But the change was attacked by NHS Alliance chair Michael Dixon. He said: “It is foolish. Consultants will have a clear provider interest in their own hospital and cannot act as disinterested commissioners.

“We need consortia to be very fast moving, lean organisations. If we do this we will make them into ambling committees that will be sitting around talking – they won’t have the hunger and drive we want to see.”

Mr Cameron’s comments appear to pre-empt the findings of the NHS Future Forum review group which is due to report on Monday or Tuesday.  HSJ understands its recommendations will include requiring consortia to have a governing body, although not who should sit on it.

Sources close to the review said it was also due to require a “stronger role” for health and wellbeing boards. Under current proposals the local authority led groups have to be “consulted” on consortium plans but have no powers to change them.

A source said the review would also recommend HealthWatch – the public and patient bodies – be given a clearer role and powers.